And Thyroid Artery Flow Murmurs

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1. What is characteristic of the timing and duration of a physiological (non-obstructive) vascular murmur?

ANS: They are early in systole and short.

2. What are the characteristics of an arterial murmur due to obstruction?

ANS: If a pressure difference across the obstruction is present in both systole and diastole, the murmur will be continuous, and the systolic murmur is always louder than the diastolic. The murmurs will have a mid- or late systolic peak if the obstruction is severe.

3. What is the difference between a bruit and a murmur?

ANS: The word bruit (pronounced "broo-ee") is French for "noise" or "sound." In France, the first and second heart sounds are the first and second bruits. Our Sj and S2 are their Bj and B2. We misuse the word to mean an arterial murmur.

4. Which arterial flow murmur may cause an ejection type of murmur at the second right or left interspace?

ANS: Rapid flow through the proximal branches of the aorta in young people. This is often mistaken for an aortic ejection murmur.

Note: A carotid murmur is present in about 80% of children up to 4 years old but is found in only 10% of those in the older age groups.

5. How can you differentiate the supraclavicular arterial murmur of childhood from a basal valvular murmur?

ANS: a. It is an arterial murmur unless it is louder on the clavicle than above it. Aortic valvular murmurs tend to be amplified on the clavicle.

b. If the arm flow is increased by a hand-clenching exercise, only the arterial murmur will become louder.

c. If the arm is stretched downward and backward, the subclavian artery is compressed between the clavicle and the first rib and the arterial murmur will diminish.

d. Compress the subclavian artery with your finger, and note how the murmur changes with varying degrees of obstruction.

Note: Listen also for a venous hum and an S3 to confirm the presence of a hyperkinetic circulation. (See Chapter j4 for a method of eliciting a venous hum.)

6. What kind of peripheral arterial murmurs are heard in coarctation?

ANS: Over the large collaterals of the back there are systolic flow murmurs with delayed onset (due to the time required for the systolic flow to reach the vessel and therefore continue beyond the S2).

Note: a. When the intercostals are collaterals, they become tortuous. Tortuosity creates turbulence. b. The murmur overlying the coarctation can be systolic or continuous, depending on the degree of aortic narrowing. The relatively high frequency requires the stethoscopic diaphragm.

7. What kind of murmur over the thyroid is heard in hyperthyroid patients?

ANS: The arterial murmur is systolic. If a continuous murmur is heard, it is a venous hum.

In the proper light, the dilated subcostal collateral arteries can be seen to pulsate.

8. What is the timing, intensity, and site of the systolic murmur often heard after aortic coronary bypass surgery?

ANS: It is a short, early ejection murmur not much more than grade 2/6, best heard when the patient is sitting up and leaning forward with held expiration. It is usually localized to the left sternal border and is usually heard only when the aortic coronary bypass is to the anterior descending artery.

Note: When the murmur disappears, the bypass has often been found to be occluded, but not necessarily [9]. When present, the graft is patent. Diminution with time may reflect a change from turbulent to laminar flow.

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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